Evaluation of modified nitrite test for diagnosing urinary tract infection in pediatrics


  • N. Aravind Babu Department of Pediatrics, Government Virudhunagar Medical College Hospital, Tamil Nadu, India




Modified nitrite test, Screening test, Urinary tract infection, Urine culture


Background: Urinary tract infection (UTI) is a common bacterial infection causing illness in children. It may be difficult to recognize UTI in children because the presenting symptoms and signs are non-specific, particularly in younger children. In addition, urine collection and interpretation of urine tests in children are not easy, and therefore, it may not always be possible to confirm the diagnosis unequivocally. The study was conducted to evaluate the value of the modified nitrite test in diagnosing urinary tract infection (UTI) in children.

Methods: The study included 150 children of both sexes, aged below 5 years, who were examined due to suspicion of UTI. The efficacy of the modified nitrite test to predict culture positivity was studied.

Results: Modified nitrite test was positive in 14 out of the 26 culture-positive urine samples (sensitivity 53.85%). The specificity, positive predictive value, and negative predictive value were 96.77%, 77.78%, and 90.91%. The overall diagnostic accuracy was 89.33%.

Conclusions: Modified nitrite test is an effective rapid screening test for diagnosing pediatric UTI.


Elder JS. Urinary tract infections. In: Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Text Book of Pediatrics. 18th ed. Ch. 538. Philadelphia, USA: Saunders. 2007;2223-4.

Senthilkumar KM, Chandrasekaran C, Anandan H, Balaji N, Sivakumar KV. Screening of Pediatric Urinary Tract Infection using Modified Nitrite Test. Int J Sci Stud. 2016;4 (3):42-4.

Gorelick MH, Shaw KN. Screening Tests for Urinary Tract Infection in Children: A Meta-analysis. Pediatrics. 1999;104;e54.

Shaw KN, Gorelick MG, McGowan KL, McDaniel Yakscoe M, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics.1998;102(2).

Hoberman A, Han-Pu C, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123:17-23.

Bauchner H, Phillipp B, Dashefsky B, Klein JO. Prevalence of bacteriuria in febrile children. Pediatr Infect Dis J. 1987;6:239-42.

Hurlbut TA, Littenberg B. The diagnostic accuracy of rapid dipstick tests to predict urinary tract infection. Am J Clin Pathol. 1991;96:582-88.

Lohr JA. Use of routine urinalysis in making a presumptive diagnosis of urinary tract infection in children. Pediatr Infect Dis J. 1991;10:646-50.

St. John A, Boyd JC, Lowes AJ, Price CP. The use of urinary dipstick tests to exclude urinary tract infection: A systematic review of the literature. Am J Clin Pathol. 2006;126:428-36.

Tahirovic H, Pasic M. A modified nitrite test as a screening test for significant bacteriuria. Eur J Pediatr. 1988;147:632-33.

Goldsmith BM, Campos JM. Comparison of urine dipstick, microscopy, and culture for the detection of bacteriuria in children. Clin Pediatr (Phila). 1990;29:214-18.

Robertson AW, Duff P. The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients. Obstet Gynecol. 1988;71:878-81.

Zulić S, Tahirović H, Imamović G, Begić H. Evaluation of the value of modified nitrite test in early detection of urinary tract infection in children. Paediatrics Today. 2011;7(2):102-09.

Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics. 1999;103:e54.






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